Provider Demographics
NPI:1679656110
Name:MARTIN, MICHAEL EMMANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EMMANUEL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 DEAN RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9614
Mailing Address - Country:US
Mailing Address - Phone:734-856-5022
Mailing Address - Fax:734-856-1022
Practice Address - Street 1:3227 DEAN RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9614
Practice Address - Country:US
Practice Address - Phone:734-856-5022
Practice Address - Fax:734-856-1022
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010146351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice